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Mental chains

Men are less likely than women to acknowledge mental health issues or seek help and support from friends, family or professionals. How can pharmacy help?

According to the Mental Health Foundation, around one in eight men in England have a common mental health problem, but the majority are reluctant to seek support or access services, preferring either to struggle on unaided or find their own ways of coping.

According to the Mental Health Foundation, around one in eight men in England have a common mental health problem, but the majority are reluctant to seek support or access services, preferring either to struggle on unaided or find their own ways of coping.

A survey commissioned by the charity revealed that men are even reluctant to discuss things with their friends and family: less than one in four (24 per cent) who have felt high levels of stress discussed this with a friend or family member. Worryingly, more men turned to the bottle than spoke about it, with 31 per cent reporting that they had started drinking alcohol or increased the amount of alcohol they drank as a result.

Emma Derbyshire, researcher, nutritionist and advisor to brain health supplement brand Equazen, says the nation’s mental wellbeing is under increasing pressure: “Depression, stress and cognitive decline have all become huge problems as we strive to keep pace with modern life,” she says. “One in four people will experience a mental health problem this year, and in any given week one in six is struggling with a problem such as anxiety and depression, according to mental health charity Mind.”

However, due to the reluctance of men to talk about mental health issues, these figures could be an underestimate. Nicky Lidbetter, chief executive of the charity Anxiety UK, says: “While it is generally recognised that fewer men than women report mental health or wellbeing [problems] – roughly one-third male (35 per cent) to two-thirds female (65 per cent) – the figures are, we believe, skewed by the under-reporting by men.”

Another sign that men are not coming forward to talk about their mental health is the prevalence of male suicide. Although there has been a significant decrease in male suicide in the UK, and the male suicide rate is the lowest in over 30 years, figures from the Office for National Statistics (ONS) show suicide is the leading cause of death for men under 50 across the country. Meanwhile, data from Samaritans claims men in the UK remain three times as likely to take their own lives compared to women.

Mental health markers

These findings are a stark illustration of how men deal with mental health problems and the fact that we should be more aware of the warning signs of men’s mental ill health.

While it can be harder to identify customers who are struggling with mental health problems – such as stress, anxiety and depression – there are several things pharmacy teams can look out for.

Stress

Stress is caused by all sorts of factors including work, relationships and so on, and in itself is not a mental health problem. However, if someone is under continuous and heavy stress it can then lead to a mental health problem like anxiety or depression.

Anxiety

The cause of anxiety disorders is not fully understood, but it is thought that genetics; traumatic life experiences or life changes such as moving home, losing a job, or pregnancy; illegal drugs; and even caffeine and alcohol can all play their part.

Symptoms of anxiety can include feeling frightened and out of control, having an increased heart rate, shortness of breath and dizziness and wanting to escape or run away.

Depression

The causes of depression differ depending on the individual and can include genetic factors; background; current employment, relationship or living situation; hormones and chemicals in the brain; lifestyle factors like being overweight or being socially isolated; use of drugs and alcohol; or having other illnesses like diabetes or cancer.

Depression has various symptoms, which may include feeling sad, empty, hopeless, irritable, anxious, or angry; a loss of interest in work, family, or once-pleasurable activities such as sex; feeling very tired, not being able to sleep, or sleeping too much; not being able to concentrate or remember details; overeating or not wanting to eat at all; thoughts of suicide or suicide attempts; aches or pains, headaches, cramps, or digestive problems; and the inability to meet the responsibilities of work, caring for family or other important activities.

Targeted support

There is growing evidence of the mental health risk new and expectant fathers face. According to NHS England, in the first six months after the birth of a baby, estimates put the prevalence rates of anxiety and depression symptoms in men at up to one in 10, while one in five women will experience a mental health problem during pregnancy and the first year after birth.

At the end of 2018, NHS England chief executive Simon Stevens announced plans for some new and expectant fathers to be offered mental health checks and treatment, as part of the NHS Long Term Plan.

This expansion of perinatal mental health services will see the partners of pregnant women and new mothers who are themselves suffering from anxiety, depression or more severe disorders, such as psychosis, automatically offered a comprehensive mental health assessment and signposted to professional support if needed. This could include peer-support, behavioural couples therapy sessions and other family and parenting interventions in specialist community perinatal mental health settings, or referral to an Improving Access to Psychological Therapies (IAPT) talking therapy programme.

Common barriers

The reasons why men are less likely to admit a problem and access support are complex. “It can, in part, be down to men accessing healthcare less than women, who typically go to see the doctor more about their children or older relatives they care for”, says Nia Charpentier from charity Rethink Mental Illness.

“We also know that men can feel under pressure to keep their emotions inside and not share how they are feeling with others, even close family members”, says Nicky.

The Men’s Health Forum says societal expectations and traditional gender roles are another barrier, suggesting it is often “fear surrounding the potential loss of masculinity” that leads to “a façade of control and stoicism, instead of honesty about reporting symptoms and accepting interventions”.

National campaigns

Nicky says this fear of talking about stress and anxiety in case it is seen as a sign of weakness that might negatively impact on their masculinity is something that Anxiety UK is addressing.

“We are working to encourage men to talk more openly about what they are feeling so they can get the help they need to overcome their anxiety without the stigmatisation that is attached to male mental health”, she says. “We are also working hard to ensure that the services that we have available for the treatment of anxiety appeal to men and are accessible. Our digital online therapy service is a good example, available via our website on an instant-access basis. In addition, throughout 2019 Anxiety UK will be working with a range of male celebrity ambassadors – themselves individuals that have experienced difficulties with anxiety – to reach out to specific groups of men that in the past have not engaged with support services.”

Rethink Mental Illness and the mental health charity Mind run the Time to Change campaign, which launched ‘In Your Corner’ in 2017 – an initiative specifically encouraging men and young people to step in and be there for their friends if they’re experiencing a mental health problem. The aim is to reach men who don’t think mental health problems are something that could affect them or the people they know. Nia says: “So far feedback shows that the campaign is working to change those very ingrained attitudes”.

Pharmacy support

Some charities now offer digital online therapy services

While we know men are less likely than women to go into a pharmacy – on average visiting four times a year, as opposed to 18 times per year for women, according to the National Pharmacy Association (NPA) – pharmacy teams are still well placed to recognise mental health issues in male customers as a consequence of over-the-counter requests for things like sleep aids for early morning waking. Simply asking them how they feel or even commenting “you don’t seem yourself at the moment – are things OK?” could be what they need to speak up about how they are.

Mental Health First Aid training is another tool that can help pharmacy teams recognise and work effectively with people who are experiencing mental health issues. This includes some of the ‘soft signs’ men may exhibit, such as presenting with physical health symptoms rather than being initially open about mental health issues.

Once a conversation has been started, there is a lot that can be done to point customers on the road to recovery, or to more help via a referral to additional support. Nicky stresses that it’s vital pharmacy teams are well equipped with plenty of information about mental health services and treatments in advance. Although this is a conversation for customers to have with the pharmacist, it is useful to have some background knowledge. For example, antidepressant medicines are commonly used to treat moderate or severe depression and can take up to six weeks before the person will notice the full effect, and they do not work in everybody.

Psychological or talking treatments, such as cognitive behavioural therapy (CBT) and counselling, have also been shown to be helpful in dealing with depression, with many health professionals considering the combination of an antidepressant with a psychological treatment to be more effective than either treatment alone.

“It is fair to say that typically pharmacies have had a long tradition of being very good at getting out information about physical health conditions via posters and other targeted campaigns”, says Nicky. “In general however, pharmacies haven’t been quite as good at getting mental health messages over. Yet with many pharmacies being accessible – having long opening hours and often being based in the heart of the community – [they] have a huge and important role to play in respect of this agenda.”

Nia adds: “We all have our part to play to normalise conversations about mental health.” The simple act of asking someone how they are feeling, being ready to listen in a non-judgemental way, and able to signpost them to sources of support, may just save their life.

Tackling the taboos

Mental health isn’t the only health issue that can be deemed taboo for men. There are several physical health conditions that can affect men and require a sensitive, non-judgemental listening ear too

Pharmacy teams can offer a listening ear to help men with common health problems

Erectile dysfunction

Erectile dysfunction (ED) is when a man can't get or keep an erection. Most men experience it at some time in their life and the causes can be physical or psychological. Physical causes include heart disease, diabetes and raised blood pressure, while psychological factors include worries about work, money, relationships, family, and even worrying about not getting an erection can all be factors. Alcohol, smoking and illegal drugs, as well as some prescription medicines, can also cause erectile problems.

It's usually nothing to worry about, but customers should be advised to see their GP if it keeps happening, as it could be a sign of an underlying health problem.

Treatment depends on the cause. If it’s physical then medicine to lower blood pressure, or statins to lower cholesterol can help. ED as a side effect of prescribed medication can be countered by changes to medicine following discussion with a GP. Lifestyle changes, such as losing weight, stopping smoking, eating healthily and exercising can also help. If ED is caused by emotional problems then counselling and cognitive behavioural therapy (CBT) may help.

Since Spring 2018, Viagra (sildenafil) has been available without prescription, but customers will need a consultation with the pharmacist to make sure it's safe for them to take.

Testicular cancer

Each year, testicular cancer affects over 2,200 men and around 60 young men will die of the disease. It most commonly affects men between the ages of 15-45 and, if caught at an early stage, men can expect a high cure rate with 98 per cent surviving the disease.

Early detection with regular self checks is therefore recommended. However, research by the male cancer charity Orchid found that over 43 per cent of men aged 18-24 in the UK were worried that their masculinity could be compromised by testicular cancer, leading to concerns that men may be put off from checking their testicles and seeking medical advice at the earliest opportunity.

The charity stresses men will still be able to function sexually if they catch the disease early: “Providing a man had two healthy testicles beforehand, the removal of one testicle for early stage testicular cancer will not usually affect a man’s sex drive or result in erectile dysfunction and he will still be able to climax and have children. It is therefore imperative that men get checked out for any testicle concerns at the earliest opportunity.”

Bladder weakness

One in four men over 40 in the UK experience urine leakage, and there are several potential causes, including side effects from medication, urinary tract infections, obesity and diabetes. Another common cause is an increasing prostate size as men age, which can put pressure on the urethra and affect a man’s ability to fully empty his bladder. This can cause symptoms of urge incontinence, including difficulty starting or stopping urinating and needing to urinate more frequently or more suddenly.

Stress incontinence can occur when coughing, sneezing, laughing or lifting weights. This type of incontinence is most common in men who have recently had prostate surgery.

Post micturition dribble (PMD), or ‘after dribble’, is the name given to the problem when men experience an involuntary loss of urine immediately after they have finished passing urine, usually after leaving the toilet. Few men admit to having this problem but many suffer from it and men of all ages can be affected.

Donna Wilson, training and brand manager for TENA Pharmacy, says: “Due to the taboo nature of the condition, bladder weakness can be a sensitive topic to discuss in pharmacy for both customers and staff. It is key to normalise the condition by reassuring them that it is a very common problem and being ready to advise on the right products to help manage the condition.

“In addition to using protective shields or pants, simple lifestyle changes can make a big difference. These include drinking fewer diuretics, planning ahead and emptying the bladder before long journeys, eating more fibre and practising pelvic floor exercises.”

Hair loss

Male pattern baldness – also known as genetic hair loss or androgenetic alopecia (AGA) – affects up to two-thirds of men in the UK.

It usually begins with a receding hairline, followed by thinning of the hair on the crown and temples, caused by hormones and genetic predisposition. Some 40 per cent of men will experience noticeable hair loss by the age of 35 and this continues to increase with age.

There is one treatment available over the counter that may help prevent the onset of hair loss or reverse early stage AGA. Minoxidil is a solution applied twice a day for at least four months. Clinical trials have shown that minoxidil can reduce hair loss by up to 90 per cent and growth may even be promoted by up to 20 per cent. Minoxidil was introduced in the 1970s for treatment of hypertension, but had the side effect of hirsutism (excessive body hair), which led to its development as a hair-growth product. How it works is unclear, but it is believed to extend the growth phase of the hair cycle, making the hair larger and encouraging resting hair to grow.

Mental Health First Aid training is another tool that can help pharmacy teams

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